On May 30, 2024 a
Miscellaneous
was filed
involving a dispute between
Miia Property And Casualty Group, Inc.,
and
Petros, James,
for Torts
in the District Court of Middlesex County.
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Y
f
DOCKET NUMBER Massachusetts Trial Court
CIVIL ACTION COVER SHEET
yy Ao Superior Court
ICOUNTY|Middlesex Superior Court (Lowell)
Plaintiff MIIA Property and Casualty Group a/s/o Wellesley Defendant: James Petros 7
ADDRESS: 15 Cabot Road ADDRESS: 3 Sprague Road
‘Wobum, MA 01801 Wellestey, MA 02181
Plaintiff Attorney: Arthur E. Maravelis / William F. Potter Defendant Attorney:
ADDRESS: 50 Mall Road, Suite 111 ADDRESS:
Burlington, MA 01803
BBO: 564673/709612 BBO:
TYPE OF ACTION AND TRACK DESIGNATION (see Instructions section on next page)
CODE NO. TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE?
Bos Motor vehicle negligence/Property damage f ves CO no
*If"Other" please describe:
ts there a claim undar G.L. c. 9347 Is there a class action under Mass. R. Civ. P. 237
CO yes No O yes No
STATEMENT OF DAMAGES REQUIRED BY ©.212,§ 34
The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff's counsel relies to determine money damages.
(Note to plaintiff: for this form, do nat state double or treble damages; indicate single damages only.)
TORT CLAIM:
|A. Documented medical expenses to date
1. Total hospital expenses wre 6 LEP or me
CLERK OF COURTS
2. Total doctor expenses: FOR THE COUNTY OF MIDOLESEX
3. Total chiropractic expenses:
MAY 3.0 2028
4. Total physical therapy expenses.
5. Total other expenses (describe below)
wis € \
| fOr CLERK il
“Subiotal (7-5): $0.00
B. Documented lost wages and compensation to date
C. Documented property damages to date $135,887.16
D. Reasonably anticipated future medical and hospital expenses
E. Reasonably anticipated lost wages
F. Other documented items of damages {describe below)
L
TOTAL (AF): $135,887.16
G. Briefly describe plaintiffs injury, including the nature and extent of the injury:
[Pamase to building after being struck by Defendant's vehicle.
CONTRACT CLAIM:
(JJ This action includes a claim involving collection of a debt incurred pursuant to a revolving credit agreement. Mass. R. Civ. P. 8.1(a).
item# Detaited Description of Each Claim Amount
1.
Total
Signature of Attorney/Seif-Represented Plaintiff: X So J] [pate 52K 2¥
RELATED ACTIONS: Please provide the case number, case name, and coynty of any related actions pending in the Superior Court.
CERTIFICATION UNDER S.J.C. RULE 1:18(5)
court-connected dispute resolution services and discuss.with SS
Thereby certify that | have complied with requirements of Rul le 5 of Su ‘ourt Rule 1:18: Uniform Rutes on Dispute Resolution, requiring that! inform my clients about
and disadvantages of the various methods of dispute resolution.
‘Signature of Attorney: X [Date: SSO GIF
‘$C0001; 02/24 wow mass.gov/courts Date/Time Printed:05-24-2024 09:49:04
Document Filed Date
May 30, 2024
Case Filing Date
May 30, 2024
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Y f DOCKET NUMBER Massachusetts Trial Court CIVIL ACTION COVER SHEET yy Ao Superior Court ICOUNTY|Middlesex Superior Court (Lowell) Plaintiff MIIA Property and Casualty Group a/s/o Wellesley Defendant: James Petros 7 ADDRESS: 15 Cabot Road ADDRESS: 3 Sprague Road ‘Wobum, MA 01801 Wellestey, MA 02181 Plaintiff Attorney: Arthur E. Maravelis / William F. Potter Defendant Attorney: ADDRESS: 50 Mall Road, Suite 111 ADDRESS: Burlington, MA 01803 BBO: 564673/709612 BBO: TYPE OF ACTION AND TRACK DESIGNATION (see Instructions section on next page) CODE NO. TYPE OF ACTION (specify) TRACK HAS A JURY CLAIM BEEN MADE? Bos Motor vehicle negligence/Property damage f ves CO no *If"Other" please describe: ts there a claim undar G.L. c. 9347 Is there a class action under Mass. R. Civ. P. 237 CO yes No O yes No STATEMENT OF DAMAGES REQUIRED BY ©.212,§ 34 The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff's counsel relies to determine money damages. (Note to plaintiff: for this form, do nat state double or treble damages; indicate single damages only.) TORT CLAIM: |A. Documented medical expenses to date 1. Total hospital expenses wre 6 LEP or me CLERK OF COURTS 2. Total doctor expenses: FOR THE COUNTY OF MIDOLESEX 3. Total chiropractic expenses: MAY 3.0 2028 4. Total physical therapy expenses. 5. Total other expenses (describe below) wis € \ | fOr CLERK il “Subiotal (7-5): $0.00 B. Documented lost wages and compensation to date C. Documented property damages to date $135,887.16 D. Reasonably anticipated future medical and hospital expenses E. Reasonably anticipated lost wages F. Other documented items of damages {describe below) L TOTAL (AF): $135,887.16 G. Briefly describe plaintiffs injury, including the nature and extent of the injury: [Pamase to building after being struck by Defendant's vehicle. CONTRACT CLAIM: (JJ This action includes a claim involving collection of a debt incurred pursuant to a revolving credit agreement. Mass. R. Civ. P. 8.1(a). item# Detaited Description of Each Claim Amount 1. Total Signature of Attorney/Seif-Represented Plaintiff: X So J] [pate 52K 2¥ RELATED ACTIONS: Please provide the case number, case name, and coynty of any related actions pending in the Superior Court. CERTIFICATION UNDER S.J.C. RULE 1:18(5) court-connected dispute resolution services and discuss.with SS Thereby certify that | have complied with requirements of Rul le 5 of Su ‘ourt Rule 1:18: Uniform Rutes on Dispute Resolution, requiring that! inform my clients about and disadvantages of the various methods of dispute resolution. ‘Signature of Attorney: X [Date: SSO GIF ‘$C0001; 02/24 wow mass.gov/courts Date/Time Printed:05-24-2024 09:49:04